加速康复外科对肝癌切除术后患者远期生存质量及体力活动的影响

Clinical application of enhanced recovery after surgery in patients with hepatic cancer and its association with long term quality of life and physical activity

目的:探讨加速康复外科对于肝癌行肝切除术后患者远期生存质量及体力活动的影响。方法:将接受加速康复外科的围手术期处理方式的42例患者设为ERA组,将接受常规处理方式的42例患者设为对照组。术前、术后1个月和3个月填写生存质量和体力活动情况问卷,采用重复测量资料的方差分析以及广义估计方程比较组间的生存质量得分以及体力活动情况。结果:ERAS组的随访完成率为92. 8%,对照组为78. 6%,组间基线资料比较差异无统计学意义(χ~2=3. 50,P=0. 061)。ERAS组的躯体功能、心理功能以及健康总分高于对照组患者(P <0. 001),ERAS组体力活动水平高于对照组(P=0. 045),体力活动达标情况比较差异无统计学意义(P=0. 220)。结论:加速康复外科可以提高肝癌行肝切除术后患者的远期生存和体力活动水平。

Objective The aim of this study was to investigate the pattern of long term quality of life and physical activity after surgery in patients with hepatic cancer undergoing enhanced recovery after surgery （ERAS）, Method 42 patients was divided into ERAS group treated with ERAS methods, other 42 patients in the control group received traditional perioperative management. All the patients were asked to answer quality of life （Qol） and international physical activity questionnaire （IPAQ） - short vision questionnaires preoperatively, one month and three months after surgery. The scores of the two questionnaire were compared between the two groups using the variance analysis of repeated measurements and generalized estimating equation method. Results The follow - up completion rate in the ERAS groups was 92. 8 % and 78.6% in the control group, the difference between the two groups was not significant（x^2 = 3.50,P = 0. 061 ）. We observed increasing scores of physical function mental function and QOL total score in quality of life questionnaire in ERAS group （P 〈 0. 001 ）. The ERAS patients had a significant higher level of physical activity estimated by the scores of IPAQ （P = 0. 045）, however no significant difference in ratio of not reaching standard be- tween the two groups（P = 0. 220）. Conclusion This study clearly demonstrated that ERAS method could increase the long term of quality of life and physical activity level in hepatic cancer after surgery.